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Association of environmental tobacco smoke at work and forced expiratory lung function among never smoking asthmatics and non-asthmatics

Zusammenhang zwischen Passivrauchbelastung am Arbeitsplatz und forcierter expiratorischer Lungenfunktion bei Nichtrauchenden mit und ohne Asthma

Association entre exposition à la fumée passive au travail et paramètres fonctionnels de l'expiration forcée chez les non-fumeurs avec et sans asthme

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Sozial- und Präventivmedizin

Abstract

Inconsistencies across studies on the association of environmental tobacco smoke (ETS) and pulmonary function may be dlarified addressing potentially susceptible subgroups. We determined the association of ETS exposure at work with FVC, FEV1, and FEF 25–75% in life-time never smokers (N=3534) of the SAPALDIA random population sample (age 18–60). We considered sex, bronchial reactivity, and asthma status as a priori indicators to identify susceptible riskgroups. The multivariate regression models adjusted for height, age, education, dustlaerosol exposure, region, and ETS at home. Overall, ETS was not significantly associated with FVC (0.7%; −0.4 to +1.8), FEV1 (−0.1%; 95% Cl:−1.3 to +1.1) or FEF 25–75% (−1.9%;−4.2 to +0.5). Effects were observed among asthmatics (n=325), FEV1 (−4.8%; 0 to−9.2); FEF 25–75% (−12.4%; −3.7 to −20.4); FVC; (−1.7%; +2.1 to −5.5), particularly in asthmatic women (n=183): FVC −4.4% (−9.6 to +1.1); FEV1: −8.7% (−14.5 to −2.5); FEF 25–75%; −20.8% (−32 to −7.6), where duration of ETS exposure at work was associated with lung function (FEV 1–6% per hour of ETS exposure at work (p=0.01); FEF 25–75%: −3.4%/h (p<0.05). In non-asthmatic women (n=1963) and in men no significant effect was observed. The size of the observed effect among susceptible subgroups has to be considered clinically relevant. However, due to inherent limitations of this cross-sectional analysis, selection or information biases may not be fully controlled. For example, asthmatic women reported higher ETS exposure at work than asthmatic men. Given the public health importance to identify susceptible subgroups, these results ought to be replicated.

Zusammenfassung

Resultate betreffend den Zusammenhang zwischen Passivrauchexposition (ETS) und spirometrischen Lungenfunktionswerten sind bei Erwachsenen inkonsistent. Wir untersuchten, ob sich ein allfälliger Zusammenhang nur bei bisher nicht berücksichtigten Risikogruppen beobachten lässt. Wir verwendeten die Spirometriedaten (FVC, FEV1, und FEF 25–75%) aller Nichtraucher (18-bis 60-jährig) der SAPALDIA-Querschnittstudie (N=3534). Die Beziehung zwischen ETS-Belastung am Arbeitsplatz (Fragebogen) und Lungenfunktion (Spirometrie) wurde analysiert. Die Faktoren Geschlecht, Asthmastatus und bronchiale Reaktivität wurden als potentielle Indikatoren der ETS-Sensitivität verwendet. In den multivariaten Regressionsmodellen kontrollierten wir für Körpergrösse, Alter, Ausbildungsstand, Staubexposition am Arbeitsplatz, Studienregion sowie ETS zu Hause. Bei Asthmatikern (n=325), nicht jedoch im Gesamtkollektiv, zeigte sich ein Zusammenhang zwischen ETS am Arbeitsplatz und schlechteren Lungenfunktionswerten (FEV1: −4,8% (0 bis −9,2); FEF 25–75%: −12,4% (−3,7 bis −20,4); FVC: −1,7% (+2,1 bis −5,5)). Bei asthmatischen Frauen (n=183) war dies besonders deutlich (FVC: −4,4% (−9,6 bis +1,1); FEV1: −8,7% (−14,5 bis −2,5); FEF 25–75%; −20,8% (−32 bis −7,6)). Verzerrungen infolge Selektion oder der subjektiven Angaben betreffend ETS-Belastung können in dieser Querschnittanalyse nicht ausgeschlossen werden. Aus Public Health Sicht bleibt die Identifikation von sensitiven Risikogruppen vordringlich.

Résumé

L'inconsistance de l'association entre exposition passive à la fumée de tabac (ETS) et fonction pulmonaire chez l'adulte pourrait être la conséquence de susceptibilités variables entre sous-groupes. L'association entre ETS au travail et fonction pulmonaire a été étudiée en utilisant les données spirométriques (FVC, FEV1 et FEF 25–75%) des non-fumeurs (âge 18–60 ans) de l'étude transversale de SAPALDIA (n=3534). Les facteurs sexe, asthme et réactivité bronchique étaient considérés comme facteurs de risque pour une sensibilité accrue à l'ETS. Des modèles multivariés sont contrôlés pour la taille, l'âge, le niveau de formation professionnelle, l'exposition à la place de travail, la région de l'étude et l'exposition domestique à l'ETS. Chez les asthmatiques, mais pas dans le collectif global, une association entre ETS au travail et diminution de la fonction pulmonaire a été démontrée (n=325) (FEV1: −4.8% (0 à −9.2); FEF 25–75%: −12.4% (−3.7 à −20.4); FVC: −1.7% (+2.1 à −5.5)). Les effets étaient particulièrement marqués chez les femmes asthmatiques (n=183) (FVC: −4.4% (−9.6 à +1.1); FEV1 −8.7% (−14.5 à −2.5); FEF 25–75%: −20.8% (−32 à −7.6)). Le design transversal de l'étude ne permet pas d'exclure des biais de sélection ou d'information sur l'exposition à l'ETS. L'identification des groupes à risque constitue un but important de la recherche en santé publique.

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Authors and Affiliations

  1. Institute for Social and Preventive Medicine, University Basle, Basle, Switzerland

    Nino Künzli, Elisabet Zemp Stutz & Ursula Ackermann-Liebrich

  2. Harvard School of Public Health, Boston

    Joel Schwartz

  3. Division of Pulmonology, CHUV, Lausanne

    Philippe Leuenberger

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  1. Nino Künzli
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Künzli, N., Schwartz, J., Zemp Stutz, E. et al. Association of environmental tobacco smoke at work and forced expiratory lung function among never smoking asthmatics and non-asthmatics. Soz Präventivmed 45, 208–217 (2000). https://doi.org/10.1007/BF01306015

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